If You Have Diabetes

The goal for diabetes management is this: controlling your blood sugar levels so they stay as near to normal as possible. Like a teeter-totter, blood sugar levels go up (hyperglycemia) and down (hypoglycemia); that's part of dealing with diabetes. Those swings can be dangerous when diet, physical activity, and medication such as insulin aren't balanced properly.

  • Too much food or too little insulin? Your blood sugar level can soar, affecting your health now and very seriously down the road.
  • Too much exercise or too much insulin? Blood sugar drops, and your body can't use blood glucose to produce enough energy. To control "the ups and the downs," carefully manage what you eat, how much, and when—no matter what type of diabetes you have. Eating raises your blood sugar level; physical activity and medication lower it. For example, in case of low blood sugar, consume a small amount of a quick-acting carbohydrate, such as V2 cup juice, followed by a small amount of protein food, perhaps a cheese cube on a cracker.

Your doctor likely will advise a regular physical activity plan to help you control your blood sugar levels and prevent weight gain, too—and may advise sensible weight loss if you're overweight. For many people, smart eating, weight loss, and active living are enough to control their blood sugar level and to maintain good health. Others need diabetes medication.

Here's some general advice about managing diabetes and preventing its symptoms. For individualized guidance that matches your needs, consult your doctor and a registered dietitian (RD). Some dietitians and nurses are certified diabetes educators (CDEs).

If you've just found out that you have diabetes, you may feel healthy. Even if it's hard to remember to stick with your eating and physical activity program, the long-term benefits are well worth the effort!

Manage Your Meals and Snacks

The game plan for smart eating with diabetes follows this general strategy: Eat about the same amount of food, in the right balance, at about the same time daily; to avoid weight gain, balance your day's food choices with regular physical activity. In the big picture, eating with diabetes follows principles of healthful eating for anybody—in fact, for your whole family. See the Dietary Guidelines in chapter 1. That can make meal management simpler.

What is the "right balance"? It's food variety with a balance of different types of food . . . portion savvy to eat the right amount of food . . . and control of energy-producing nutrients (carbohydrates, fats, and proteins).

For diabetes, there's no single eating plan; the guidelines have built-in flexibility. The amount and proportions of carbohydrates, proteins, and fats—the energy nutrients—you consume depend on you and your weight, blood cholesterol levels, and medical

Food Guide for Diabetes: A Guide to Amounts

This food guide for diabetes can be your daily eating plan, especially for type 2 diabetes. Follow this serving guide, based on your day's calorie needs.

Servings for Servings for Servings for

1,600 2,000 2,400

Categories calories Calories Calories A Serving Is*

Starchy foods (bread, cereal, 6 rice, pasta, beans, and starchy vegetables)

Vegetables (except for starchy vegetables)


Milk and yogurt

Meat or meat substitutes


Up to 3

1 slice bread V3 cup rice V2 cup cooked cereal 3/4 cup dry cereal flakes 1 small baked potato V2 cup cooked legumes (dry beans)

V2 cup tomato juice

V2 cup cooked green or deep yellow vegetables 1 cup raw, leafy greens

1 small apple V2 cup fruit juice

2 tbsp. dry fruit

V2 cup canned fruit

1 cup fat-free milk

8 ounces nonfat yogurt

2 to 3 oz. cooked fish, chicken, or lean meat

2 oz. cheese V2 cup tofu

1 tbsp. regular salad dressing

1 tsp. regular margarine or oil

2 tbsp. light salad dressing 1 tbsp. light mayonnaise

1 bacon strip 6 whole peanuts

*Ask a registered dietitian or a certified diabetes educator where other foods fit.

Source: National Institute of Diabetes and Digestive and Kidney Diseases, 2003.

needs. Specific food choices are up to you, too, and what foods you enjoy. Your doctor, along with a registered dietitian, can help you plan what's right for you—portion sizes, types of food, and overall timing.

Portion savvy is important in diabetes management. Get out your measuring cups and spoons, and the kitchen scale. Measure your portions, as well as your cups, bowls, and dishes, until you get familiar with serving sizes.

Tip: People with diabetes often have high blood pressure and risks for heart disease, or they may acquire these conditions down the line. As precautions, eat for heart health and control your salt/sodium intake if you have diabetes. Talk to your healthcare provider for guidance. See "Your Healthy Heart" and "BloodPressure: Under Control?" in this chapter.

Food Guide for Diabetes. The food guide for diabetes is a starting point to plan meals and snacks for diabetes management. It's similar to MyPyramid shown in chapter 10, but adjusted to help people with diabetes manage carbohydrates and other energy nutrients more easily. As you look at this guide, notice:

  • The guide has "Starchy foods" with grain products, as well as starchy vegetables (potatoes, legumes, corn).
  • quot;Meat and meat substitutes" include fish, poultry, meat, and tofu, as well as cheese. Despite their protein content, legumes (dry beans) fit with "starchy foods."
  • The "Milk and yogurt" group doesn't include cheese.

It's well known that sugar doesn't cause diabetes; neither do any carbohydrates. Sugar doesn't cause blood sugar levels to rise any more than starches do. Starches (pasta, rice, bread, fruits and vegetables, and other starchy foods) and sugars have a similar effect on blood sugar levels. People with diabetes can fit small amounts of sugary foods into their eating plan as carbohydrate foods. For diabetes management, the total carbohydrates consumed counts, not just sugars. Caution: Many sugary foods are low in nutrients and high in fat.

If you like sweet flavors, then very-low-calorie sweeteners (acesulfame potassium, aspartame, saccharin, and sucralose) offer some choices without increasing your blood sugar level or adding calories.

For example, look for diet soft drinks, sugar-free candy, and ice cream with these sweeteners. These foods may allow you to fit other foods in. For example, by choosing yogurt sweetened with an intense sweetener instead of sugared fruit, you might fit toast, a muffin, or crackers into your eating plan, too. Warning: If you have the disorder phenylketonuria (PKU), avoid foods sweetened with aspartame. See "Aspartame: PKU Warning" in chapter 21.

Polyols (sorbitol, mannitol, and xylitol) are sweeteners with fewer calories than sugar. They affect blood sugar level, but not as much as sugar and other nutritive sweeteners do. See "Intense Sweeteners:

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